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The clinical outcomes of chronic hepatitis C in South Korea: A prospective, multicenter cohort study
Kyeong Sam Ok1, Sook-Hyang Jeong, Eun Sun Jang
1Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan Departement of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University College of Medicine, Jeonju Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun Department of Internal Medicine, The Catholic University of Korea, Seoul Saint Mary's Hospital Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Insights
Chronic hepatitis C patients in Asia showed modest outcomes but significant disease progression in older individuals and those with low platelets or no sustained virologic response (SVR). Early treatment, potentially with direct-acting antivirals, is crucial for better clinical outcomes.
Area of Science:
- Hepatology and Gastroenterology
- Viral Hepatitis Research
- Clinical Outcomes and Prognosis
Background:
- Chronic hepatitis C (CHC) poses a significant health burden globally.
- Understanding CHC progression in hepatitis B-dominant Asian regions is crucial for targeted interventions.
- Limited data exists on long-term clinical outcomes of CHC in Korean populations.
Purpose of the Study:
- To determine the clinical outcomes of chronic hepatitis C patients in a hepatitis B-dominant Asian region.
- To identify factors associated with disease progression, including liver cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma (HCC).
- To evaluate the impact of sustained virologic response (SVR) on overall survival.
Main Methods:
- Prospective cohort study involving 382 treatment-naive CHC patients without cirrhosis.
- Regular follow-up for a median of 39.0 months to monitor for liver cirrhosis, decompensation, HCC, and survival.
- Analysis of factors influencing clinical outcomes, including age, platelet count, and SVR achievement.
Main Results:
- Significant progression observed: 11.0% developed cirrhosis, 1.0% decompensated cirrhosis, and 3.1% HCC.
- Cumulative 5-year probabilities: 16.7% for cirrhosis and 4.5% for HCC.
- Key predictors of poor outcomes: age ≥55 years, platelet count <150 × 10/L, and failure to achieve SVR.
Conclusions:
- Korean CHC cohort demonstrated modest mortality but significant disease progression.
- Older age, low platelet count, and non-SVR are associated with adverse clinical outcomes.
- Direct-acting antiviral therapy should be prioritized for patients at high risk of progression.
Abstract:
This prospective cohort study aimed to elucidate the clinical outcome and its related factors of chronic hepatitis C in a hepatitis B-dominant Asian region.From January 2007 to October 2012, 382 patients with chronic hepatitis C without liver cirrhosis were prospectively enrolled at 6 university hospitals, and regularly followed until Apr 2014 to identify the development of liver cirrhosis, decompensated cirrhosis, hepatocellular carcinoma (HCC), and overall survival.During the median follow-up of 39.0 months (range 18.0-81.0 months), liver cirrhosis, hepatic decompensation, and HCC developed in 42 patients (11.0%), 4 patients (1.0%), and 12 patients (3.1%), respectively. The cumulative probability of development of cirrhosis at 3 years and at 5 years was 9.6% and 16.7%, respectively. That of HCC at 3 and 5 years was 1.6% and 4.5%, respectively. The 3-year and 5-year overall survival rate was 99.7% and 96.0%, respectively. Pegylated interferon-based antiviral therapy was undertaken in 237 patients (62.0%) with a sustained virologic response (SVR) rate of 74.3%. The factors related to the overall clinical outcomes were age ≥55 years (HR 2.924, P = 0.016), platelet counts <150 × 10/L (HR 3.195, P = 0.007), and the achievement of SVR (HR 0.254, P = 0.002).The clinical outcomes of this Korean chronic hepatitis C cohort were modest with minimal mortality, but significant disease progression occurred in the patients with old age, low platelet, and non-SVR after interferon-based antiviral treatment or no treatment, suggesting priority for direct acting antiviral therapy.
